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Md. programs to educate about cancer

02/05/01

Armed with nearly $16 million from the national tobacco settlement, health officials are launching a statewide blitz to fight a silent, often overlooked killer: colorectal cancer.

As public awareness and screening programs take shape this year, Marylanders - whether sitting in church, surfing the Internet or talking with a neighbor - can expect a swarm of messages about a cancer that is the second-deadliest in the state.
"Our mission is simple: We've got to save lives," Dr. Ebenezer Israel, St. Mary's County health officer, said of the campaigns, which will be run by local health departments. "We're going to hit people on many fronts: at work, at play, in the community. It's going to come from 20 different angles."
Anne Arundel County plans to train church members in minority communities to talk about colorectal cancer - which affects the colon and rectum - and other health issues.
Howard County is developing a cancer resource directory that will be posted online and distributed to libraries, providing information on screening, diagnosis and treatment.
In Baltimore and Queen Anne's counties, health officials plan to recruit "ambassadors for colorectal cancer awareness" - volunteers to spread information to family, friends and acquaintances.
St. Mary's County, awarded a $212,936 prevention grant in October, plans a bimonthly newsletter to educate physicians about the importance of colorectal screenings, and a "Prevention Bus" to bring cancer education to the public.
Although most of the settlement money will be aimed at colorectal cancer, it also will bolster programs battling six other cancers targeted by the state Health Department: lung, breast, prostate, cervical, oral and skin. In Baltimore, officials are developing a program with the Johns Hopkins University and the University of Maryland, Baltimore and will most likely choose prostate and cervical cancers as priorities.
The local programs have been made possible by the first wave of money - nearly $16 million in grants - to come out of the Cigarette Restitution Fund, created from Maryland's slice of the national tobacco settlement. By law, that money must be used to fight cancer and reduce tobacco use.
During the next 25 years, Maryland is expected to receive $4.2 billion from tobacco companies, and Gov. Parris N. Glendening has committed $1 billion to the fund over the next 10 years. Community-based campaigns aimed at tobacco use will begin this year, state health officials said.
Colorectal cancer kills more than 56,000 Americans annually, including more than 1,000 Marylanders.
In Maryland, it is the second-leading cause of cancer deaths after lung cancer. Maryland has the nation's third-highest colorectal cancer mortality rate, after New Jersey and the District of Columbia, according to 1997 statistics from the National Cancer Institute.
Public health officials hope the tobacco settlement funds will help change those statistics.
"It's a silent cancer. By the time people know they have it, it's usually too late," said Israel, the health officer of St. Mary's County, the first locality to receive a cancer prevention grant.
Colorectal cancers are thought to develop slowly over several years. Before cancer develops, precancerous growths, called polyps, usually appear in the lining of the colon or rectum.
Certain types of tumors increase the risk of developing colorectal cancer, and experts say early detection and removal of the polyps prevent them from turning cancerous.
In the early stages, when cure rates are high, the disease often does not produce signs or symptoms. Nearly 59 percent of Maryland cases are diagnosed at a late stage.
"Out of all the cancers, it's probably the easiest to detect and eradicate, but it requires screening most people don't want to do," said Dr. Carlessia A. Hussein, executive director of the Cigarette Restitution Fund Program.
In one screening method known as a colonoscopy, a flexible tube with a lighted viewing device is inserted into the rectum and threaded through the large intestine to detect polyps.
Polyps become more common as people get older, which is why Marylanders older than age 50 - especially the poor and uninsured - are targets of the new colorectal cancer campaigns.
Howard County is developing a screening program for seniors, providing exams for uninsured residents with incomes 250 percent below the federal poverty level.
Most counties are also launching outreach programs aimed at minorities, to address disparities in cancer screening and treatment.
Statewide colorectal cancer rates are higher among African-Americans than whites, though the rates vary widely among localities.
Baltimore County, for example, has 101 cases per 100,000 African-Americans and 49 cases per 100,000 whites, state statistics show. In Montgomery County, there are 58 cases per 100,000 African-Americans, compared with 39 per 100,000 for whites. In Baltimore, by contrast, whites have a slightly higher incident rate than African-Americans.
Montgomery County plans to spend $40,000 a year to hire a full-time health educator to teach African-Americans about cancer issues and to recruit poor, uninsured residents between age 50 and 64 for colorectal screenings.
St. Mary's County has formed a minority outreach coalition that provides information and detection kits to African-Americans and Latinos.
Last year, localities were asked to submit proposals for using tobacco funds to battle the seven cancers targeted by the state Health Department. In proposal after proposal, local health departments ranked colorectal cancer as the prime target.
The money is allocated according to a two-part formula, and localities with the most cancer cases and highest cancer death rates receive the most money. Baltimore topped the list.
Local health officials credit "Today" show co-host Katie Couric with increasing awareness about colon cancer. Couric has been an advocate since her husband, TV legal analyst Jay Monahan, died in 1998 from the disease, which was discovered too late.
In March, during National Colorectal Cancer Awareness Month, Couric underwent a colon exam on the air, a move that sent a flood of people to call doctors for checkups.
It reportedly was the strongest wave of public interest in the disease since 1985, when President Ronald Reagan had surgery for colon cancer.
"Couric has helped people become aware of this, but we still have a lot of work to do," said Marsha Bienia, director of the state Health Department's Center for Cancer Surveillance and Control. "Only about 30 percent of [Maryland] adults are getting screened, so there's a need for public awareness."
But health officials say they are up to the challenge. Said Israel: "In six months time, colon cancer is all people will know about."